Basic Information
| Provider Information | |||||||||
| NPI: | 1811235823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | ELVIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1913 | ||||||||
| Address2: | |||||||||
| City: | CASHIERS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287171913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287436312 | ||||||||
| FaxNumber: | 8287431973 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 HIGHWAY 64 EAST | ||||||||
| Address2: | |||||||||
| City: | CASHIERS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287436312 | ||||||||
| FaxNumber: | 8287431973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16048 | NC | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 19140 | FL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.